**Primary City/State:** Colorado, Colorado **Department Name:** AZ Pop Health-Clinic **Work Shift:** Varied **Job Category:** Nursing **Primary Location Salary Range:** $33.74 - $56.24 / hour, based on education & experience In accordance with State Pay Transparency Rules. Find your path in health care. Banner Health is committed to not only providing the finest care possible, but to advancing the way care is provided. To achieve our vision, we seek out professionals who embrace change and who possess the passion and skills to make it happen. Apply today. **Schedule:** **The hours to begin will be M-F, 8 hour shifts. We are flexible on start times e.g. 7am-3:30, 8am-4:30, etc. As the person gets trained and up to speed, I would be open to flexing the schedule to something like 4 days/week, 10 hour shifts if the workflows and other scheduling allow.** Location: This is a remote position. Due to the nature of this of this role, ability to occasionally work onsite with providers and primary care clinics is preferred/helpful. Preference will be given to candidates in the Northern Colorado area. Job Duties: This role is critical in providing appropriate information for providers for the management of risk adjustable chronic conditions by utilizing thorough chart reviews and problem list management. The RN works in collaboration with the primary care provider and all members of the risk adjustment team. Responsibilities include identification of Medicare and Medicare Advantage patients, identification of risk adjustable chronic conditions and applying clinical knowledge to support providers in their documentation and medical decision making. Day to day: This position requires expertise in the nursing process, using critical thinking skills to plan and coordinate care. Nursing experience in primary care, community nursing, critical care (ICU/ED) or utilization/prior authorization review would be helpful but not required. Knowledge/Experience with Risk Adjustment and Quality Measures (Stars, HEDIS) very helpful. Proficient ability to use a computer (required), Microsoft Office (required) and familiarity with Cerner (helpful). We find nurses with 10 or more years experience do well in this role. ADN or BSN required as well as active license in state of residence. At Banner Medical Group, you'll have the opportunity to perform a critical role in the community where you practice. Banner Medical Group provides both primary and specialty care throughout the communities in which Banner Health operates. We do this in a variety of settings - from smaller group practices like our Banner Health Clinics in Colorado and Wyoming, to large multi-specialty Banner Health Centers in the metropolitan Phoenix area. We currently have more than 1,000 physicians and more than 3,500 total employees in our group and are seeking others to enhance our ability to deliver our nonprofit mission of providing excellent patient care. POSITION SUMMARY This position provides clinical and operational coordination of all Risk Adjustment efforts in support of achieving organizational strategic initiatives related to the organization’s Risk Adjustment program goals. This position is also responsible for understanding and serving as an informative source on Medicare Advantage funding models (Risk adjustment, HCCs, HEDIS quality Rate, etc.) This includes collaborating with key stakeholders to implement the activities across BMG and to identify opportunities for optimization of RAF scores and capture of Hierarchical Condition Categories (HCCs). CORE FUNCTIONS 1. Serves as a subject matter expert in support of Risk Adjustment Factor (RAF) tools for Banner Medical Group. Coordinates the business design, testing and implementation of web-based RAF tools and reports in areas of expertise. Monitors and ensures tools are available post implementation. Responsible for the development and implementation of Risk Adjustment education and training for network physicians and practices, including documentation and coding requirements, HCCs, HEDIS quality ratings. 2. Establishes and promotes a collaborative relationship with physicians, third party vendors, and other members of the health care team. Collects and communicates pertinent, timely clinical information to third party vendors and others to fulfill utilization and regulatory requirements. 3. Assess accuracy and comprehensiveness of HCC recapture to ensure that diagnosis opportunities are identified timely and appropriately, with a goal to optimize the program’s financial benefit to Banner Health. 4. Partners with Risk Adjustment resources to provide guidance on utilization of Risk Adjustment tools. Provides formal training and supports physicians and practices in the day to day utilization of Risk Adjustment tools throughout Banner Medical Group. 5. Serves as primary contact with external physicians and practices for escalated issue resolution related to Banner RAF tools. Identifies trends and escalates issues as required to ensure proper resource management, customer satisfaction and issue resolution. Develops and implements recommendations to improve business processes to support and/or optimize RAF scores. Works collaboratively with ambulatory care management to ensure quality performance criteria expectations are disseminated so physicians and practices are equipped to meet and/or exceed clinical targets. 6. Accesses and interprets data from a variety of sources to gain full understanding of Risk Adjustment trends and educational opportunities. Meets regularly with BMG workforce team to review findings and develop an improvement plan to meet organizational goals. Partners with Risk Adjustment Quality Analysts and Educators to develop educational materials. Meets regularly with workforce teams to support communication and promote partnership. 7. Participates in or leads Risk Adjustment projects designed to improve program offerings or address system limitations. This may include analysis of BMG Practice Management systems, clearinghouse routing, vendor routing and/or CMS submissions. 8. Monitors data submission for attestation to CMS for Risk Adjustment. This position also analyzes and monitors clinical Risk Adjustment reports to and from CMS to ensure data accuracy and compliance. Reviews, prepares, analyzes, and presents reports and as needed. 9. This subject matter expert role will interface on a regular basis with all levels at assigned facilities/entities. This position will also interact with both internal resources and external vendors. MINIMUM QUALIFICATIONS Must possess a strong knowledge of healthcare provider relations as normally obtained through 3-5 years of related healthcare experience. Must possess a current, valid RN license in the state of practice. Must demonstrate effective relationship development skills, and ability to effectively communicate in individual and group settings. Teamwork is critical. Attentive listening and polished presentation skills are needed to effectively educate providers and practices on Risk Adjustment tools. Requires critical thinking and project management capabilities. Position requires proficiency in personal software applications, including word processing, generating spreadsheets, claims adjudication and provider systems. PREFERRED QUALIFICATIONS Additional related education and/or experience preferred. **Anticipated Closing Window (actual close date may be sooner):** 2025-06-05 **EEO Statement:** EEO/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo) Our organization supports a drug-free work environment. **Privacy Policy:** Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy) EOE/Female/Minority/Disability/Veterans Banner Health supports a drug-free work environment. Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability